The use of herbal therapies is increasing in the United States. Because of the rise in the use of herbal therapy, the following is presented to provide some basic information on some of the more popular herbs. Please note this is not an all-inclusive list, which is beyond the scope of this handbook.
| Name | Uses | Comments |
| Aloe vera | Orally: osteoarthritis, inflammatory bowel diseases (e.g., ulcerative colitis), fever, itching, inflammation.
Topically: burns, wound healing, psoriasis, sunburn, frostbite, cold sores. | Well tolerated. Orally can cause abdominal pain, cramps; topically can cause burning, itching, contact dermatitis.
May lower blood glucose levels and have additive effects with antidiabetic medications. |
| Bilberry | Orally: improve visual acuity (e.g., night vision, cataracts), atherosclerosis, chronic fatigue syndrome, venous insufficiency, varicose veins, hemorroids.
Topically: mild inflammation of mouth and throat mucous membranes. | Can inhibit platelet aggregation, increase risk of bleeding when combined with antiplatelet or anticoagulant medications (e.g., aspirin, clopidogrel, enoxaparin, warfarin).
May lower blood glucose. |
| Bitter orange | Orally: appetite stimulant, dyspepsia.
Topically: inflammation of the eyelid, conjunctiva, retina. | May cause hypertension, cardiovascular toxicity.
May increase concentration/effects of midazolam; concurrent use with MAOIs may increase blood pressure (avoid use); combination with caffeine can increase blood pressure, heart rate. |
| Black cohosh | Orally: symptoms of menopause, premenstrual syndrome (PMS), dysmenorrhea, dyspepsia, inducing labor in pregnant women, anxiety, fever, cough, cardiovascular disease, cognitive function, infertility, osteoarthritis, osteoporosis, rheumatoid arthritis.
Topically: acne, mole, and wart removal; improve skin appearance. | Can cause GI upset, rash, headache, dizziness, increased weight, cramping, breast tenderness, vaginal spotting/bleeding.
May decrease effects of cisplatin; may increase risk of hepatic damage with hepatotoxic medications. |
| Capsicum (cayenne pepper) | Orally: dyspepsia, flatulence, diarrhea, cramps, toothache, hyperlipidemia.
Topically: pain of shingles, osteoarthritis, rheumatoid arthritis, postherpetic neuralgia, diabetic neuralgia, trigeminal neuralgia. | Orally can cause upper abdominal discomfort (e.g., gas, bloating, nausea, diarrhea, belching); topically can cause burning, stinging, erythema.
May increase effects/adverse effects of antiplatelet medications. |
| Chamomile | Prepared as a tea and used as a mild sedative, relaxant, and sleeping aid; used for indigestion, itching, and inflammation. | Large amounts may cause vomiting. |
| Chastberry | Orally: menstrual irregularities (e.g., dysmenorrhea, amenorrhea, metrorrhagia). | Can cause GI upset, headache, diarrhea, nausea, itching, urticaria, rash, insomnia, increased weight, irregular menstrual bleeding.
Can interfere with efficacy of oral contraceptives, hormone replacement therapy. |
| Clove (clove oil) | Orally: dyspepsia, expectorant, diarrhea, halitosis, flatulence, nausea, vomiting.
Topically: toothache, mouth and throat inflammation. | Topically can cause tissue irritation, allergic dermatitis. |
| Co-enzyme Q-10 | Heart failure, angina, diabetes, hypertension. | Can cause GI side effects (e.g., nausea, vomiting, diarrhea, appetite suppression, heartburn, epigastric discomfort).
Can decrease blood pressure and have an additive effect with antihypertensive medications; may reduce anticoagulant effects of warfarin. |
| Cranberry | Prevention/treatment of urinary tract infections, neurogenic bladder, urinary deodorizer in incontinence, kidney stones, prevention of urinary catheter blockage. | Usually well tolerated. Large amounts can cause GI upset, diarrhea, nausea, vomiting.
Greater than 1, 000 ml daily can increase risk of uric acid, kidney stone formation. |
| DHEA | Slow or reverse aging, weight loss, metabolic syndrome, increase immune and cognitive function. | At high dose can cause acne, hirsutism, hair loss, voice deepening, insulin resistance, altered menstrual pattern.
May interfere with antiestrogen effects of anastrozole, letrozole, or other aromatase inhibitors; may overcome estrogen receptor antagonist activity of tamoxifen in estrogen receptor positive cancer cells. |
| Dong quai | Dysmenorrhea, premenstrual syndrome, menopausal symptoms. | May cause photosensitivity and photodermatitis.
May increase effect/risk of bleeding with antiplatelet and anticoagulant medications (e.g., aspirin, warfarin). |
| Echinacea | Treat/prevent common cold, influenza, other upper respiratory tract infections. | Usually well tolerated. Can cause GI effects (e.g., nausea, abdominal pain, diarrhea, vomiting).
Stimulates immune function—may exacerbate autoimmune diseases (e.g., multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosis). |
| Eucalyptus | Orally: infections, fever, dyspepsia, expectorant for coughs.
Topically: inflammation of respiratory tract mucous membranes, rheumatoid arthritis, nasal stuffiness. | Orally: GI effects (e.g., nausea, vomiting, diarrhea).
Topically (prolonged exposure/large amounts): agitation, drowsiness, muscle weakness, ataxia. |
| Evening primrose oil | Premenstrual syndrome (PMS), endometriosis, symptoms of menopause (e.g., hot flashes). | May increase risk of bruising/bleeding with antiplatelet/anticoagulant medications (e.g., aspirin, clopidogrel, enoxaparin, warfarin). |
| Feverfew | Orally: fever, headaches, prevention of migraines, menstrual irregularities.
Topically: toothaches, antiseptic. | Orally: GI effects (e.g., heartburn, nausea, diarrhea, constipation, abdominal pain, bloating, flatulence).
Topically: contact dermatitis. May have additive effects, increase risk of bleeding with antiplatelet medications. |
| Fish oil | Hyperlipidemia, hypertriglyceridemia, hypertension, stroke, depression, rheumatoid arthritis, osteoporosis, psoriasis, Crohn’s disease. | Can cause a fishy aftertaste, halitosis, heartburn, dyspepsia, nausea, loose stools, rash.
May have additive effect with antihypertensive medication. |
| Garlic | Hypertension, hyperlipidemia, age-related vascular changes, atherosclerosis, chronic fatigue syndrome, menstrual disorders, coronary heart disease, peripheral arterial disease. | Dose-related effects including breath/body odor, mouth and GI burning/irritation, heartburn, flatulence, nausea, vomiting, diarrhea.
May increase effects of antiplatelets (e.g., aspirin, clopidogrel, enoxaparin), anticoagulants (e.g., warfarin); may decrease effects of oral contraceptives, cyclosporine, protease inhibitors, and non-nucleoside reverse transcriptase inhibitors (NNRTIs). |
| Ginger | Motion sickness, morning sickness, dyspepsia, rheumatoid arthritis, osteoarthritis, loss of appetite, migraine headache, diarrhea, flatulence, irritable bowel syndrome, dysmenorrhea. | Usually well tolerated. At high doses of 5 g/day may cause abdominal discomfort, heartburn, diarrhea, irritant effect in mouth and throat.
May increase risk of bleeding with antiplatelet medications and anticoagulants (e.g., aspirin, clopidogrel, enoxaparin, warfarin). |
| Ginkgo | Dementia (including Alzheimer’s), vascular dementia, mixed dementia. | Mild GI upset, headache, dizziness, constipation, palpitations, allergic skin reactions. Large doses can cause diarrhea, nausea, vomiting, weakness.
Decreases platelet aggregation; may increase risk of bleeding with antiplatelet and anticoagulants (e.g., aspirin, clopidogrel, enoxaparin, warfarin). |
| Ginseng | Increases resistance to environmental stress, improves well-being, boosts energy, diuretic. | May cause insomnia, vaginal bleeding, headache, hypertension, hypotension, decreased appetite, edema.
May decrease effectiveness of warfarin. |
| Glucosamine | Osteoarthritis, glaucoma, temporomandibular joint arthritis. | May cause mild GI effects (e.g., nausea, heartburn, diarrhea, constipation).
May increase risk of bleeding with anticoagulants (e.g., warfarin). |
| Gotu kola | Reduce fatigue, anxiety, depression, improve memory and intelligence. | May cause GI upset, nausea, drowsiness.
May cause additive sedative effects/side effects with CNS depressants (e.g., clonazepam, lorazepam, zolpidem). |
| Grapefruit | Hyperlipidemia, atherosclerosis, weight loss and obesity. | May increase concentrations/effects of benzodiazepines, calcium channel blockers, carbamazepine, carvedilol, clomipramine, cyclosporine, estrogens, lovastatin, simvastatin, atorvastatin. |
| Green tea | Improves cognitive performance and mental alertness. | Can cause nausea, vomiting, abdominal bloating, dyspepsia, flatulence, diarrhea. Higher doses can cause dizziness, insomnia, fatigue, agitation.
May increase effects of amphetamines, caffeine. |
| Hawthorn | Congestive HF, coronary heart disease, angina, arrhythmias. | Generally well tolerated. Can cause vertigo, dizziness, nausea, GI complaints, fatigue, sweating, rash. |
| Kava kava | Anxiety disorders, stress, attention-deficit hyperactivity disorder (ADHD), insomnia, restlessness. | GI upset, headache, dizziness, drowsiness, enlarged pupils and disturbances of oculomotor equilibrium and accommodation, dry mouth, allergic skin reactions.
May increase drowsiness, motor reflex depression with alcohol, benzodiazepines, other CNS depressants. |
| L-carnitine | Treatment of primary L-carnitine deficiency, acute myocardial infarction, supplement to total parenteral nutrition, L-carnitine deficiency in those requiring hemodialysis. | Can cause nausea, vomiting, abdominal cramps, heartburn, gastritis, diarrhea, body odor, seizures. |
| Licorice | Gastric and duodenal ulcers, sore throat, bronchitis, dyspepsia, cough, osteoarthritis, chronic gastritis, menopausal symptoms, osteoporosis, bacterial/viral infections. | Excessive ingestion can cause pseudohyperaldosteronism with sodium and water retention, hypokalemia, alkalosis. May lead to hypertension, edema, arrhythmias.
May reduce effect of antihypertensive medication therapy, warfarin. |
| Melatonin | Jet lag, insomnia, shift-work disorder. | Can cause daytime drowsiness, headache, dizziness.
May increase effect of antiplatelets, anticoagulants (e.g., aspirin, clopidogrel, enoxaparin, warfarin). May cause additive sedation with CNS depressants (e.g., alcohol, benzodiazepines). |
| Milk thistle | Liver disorders, chronic inflammatory liver disease, hepatic cirrhosis, chronic hepatitis. | Usually well tolerated. Can cause nausea, diarrhea, dyspepsia, flatulence, abdominal bloating, anorexia. |
| Nettle | Urinary disorders associated with benign prostatic hyperplasia (e.g., nocturia, frequency, dysuria, urinary retention). | Generally well tolerated. May cause GI complaints, sweating, allergic skin reactions.
May decrease effects of warfarin. |
| Peppermint | Common cold, cough, inflammation of mouth and pharynx, sinusitis, fever, cramps of upper GI tract, dyspepsia, flatulence, irritable bowel syndrome (IBS), fever, tension headache. | Can cause heartburn, nausea, vomiting, allergic reactions including flushing and headache.
May increase concentration/effects of cyclosporine. |
| Red yeast | Maintain desirable cholesterol levels in healthy people; reduce cholesterol in hyperlipidemia; indigestion; diarrhea; improve blood circulation. | Can cause abdominal discomfort, heartburn, flatulence, dizziness.
May increase cyclosporine concentration. |
| SAMe | Depression, anxiety, heart disease, fibromyalgia, osteoarthritis, tendonitis, dementia, Alzheimer’s disease, Parkinson’s disease. | Higher doses can cause flatulence, nausea, vomiting, diarrhea, constipation, headache, mild insomnia, anorexia, sweating, dizziness, nervousness.
May have additive adverse effects with MAOIs including hypertension, hyperthermia, agitation, confusion, coma. May have additive serotonergic effects and serotonin syndrome-like effects (e.g., agitation, tremors, tachycardia, diarrhea, hyperreflexia, shivering, diaphoresis) with antidepressants. |
| Saw palmetto | Symptoms of benign prostatic hyperplasia (BPH). | Can cause dizziness, headache, GI complaints (e.g., nausea, vomiting, constipation, diarrhea).
May increase effect of antiplatelets, anticoagulants (e.g., aspirin, clopidogrel, enoxaparin, warfarin). May interfere with contraceptives. |
| St. John’s wort | Depression, anxiety, heart palpitations; mood disturbances associated with menopause, ADHD, obsessive-compulsive disorder (OCD), seasonal affective disorder (SAD), premenstrual syndrome (PMS), social phobia. | Usually well tolerated. Can cause insomnia, vivid dreams, restlessness, agitation, irritability, GI discomfort, diarrhea, fatigue, dry mouth, dizziness, headache.
May decrease effect of alprazolam, amitriptyline, oral contraceptives, cyclosporine, imatinib, irinotecan, NNRTIs, phenytoin, protease inhibitors, tacrolimus, warfarin. May cause additive serotonergic effects with antidepressants, paroxetine, sertraline, tramadol. |
| Turmeric | Osteoarthritis, rheumatoid arthritis, dyspepsia, abdominal pain, Crohn’s disease, ulcerative colitis, diarrhea, flatulence, loss of appetitie, hepatitis, H. pylori, peptic ulcers, irritable bowel syndrome. | Usually well tolerated. Can cause dyspepsia, diarrhea, distention, GERD, nausea, vomiting.
May increase risk of bleeding with antiplatelets/anticoagulants. May increase risk of hypoglycemia with antidiabetic drugs. |
| Valerian | Insomnia, anxiety-associated restlessness, sleeping disorders. | Can cause headache, excitability, insomnia, gastric discomfort, dry mouth, vivid dreams, morning drowsiness.
May have additive sedative effects with alcohol, benzodiazepines, other CNS depressants. |
| Yohimbe | Aphrodisiac, impotence, exhaustion, angina, hypertension, diabetic neuropathy, postural hypotension. | Can cause excitation, tremors, insomnia, anxiety, hypertension, tachycardia, dizziness, irritability, headache, fluid retention, rash, nausea, vomiting. High doses can cause respiratory depression.
May have additive effects with MAOIs. Tyramine-containing foods increase risk of hypertensive crisis. |